Child Obesity Prevention Programs: Where Is the Evidence?

Introduction: The Resource Center for Obesity Prevention at the Clearinghouse for Military Family Readiness at Penn State has a database of child obesity prevention programs (manualized protocols currently available for dissemination to the public). Program components include: improving nutrition/diet; increasing physical activity; and reducing screen time; and use four strategies to promote behavior change: education, behavior-modification, environmental-modification, and direct strategies. We compared the components and strategies of programs with evidence of effectiveness for primary obesity outcomes (i.e., improved BMI) and secondary obesity outcomes (i.e., improved behaviors that positive/y obesity outcomes), to programs that lack evidence of effectiveness.

Methods: Of 262 child obesity programs reviewed and placed on the Clearinghouse Continuum of Evidence, 42 included evaluations of primary and/or secondary obesity outcomes. Components and strategies of programs with significant versus non-significant primary only (n=3) and primary and secondary (n=18) obesity outcomes were compared. The impact of including parents (i.e., ‘no parent involvement’ to ‘required’) on program outcomes was also assessed.

Results: Programs that incorporated a ‘reducing screen time’ component (X²[1] = 7.29, p = 0.007) or education-based strategies (X²[1] = 4.04, p = 0.044) were significantly more likely to yield significant obesity outcomes. Most programs (83.3%) with a ‘reducing screen time’ component had significant positive obesity outcomes, whereas most programs (80%) that did not incorporate ‘reducing screen time’, did not yield significant outcomes. Programs that lacked education-based strategies did not yield significant obesity outcomes. Programs with significant obesity outcomes also had a higher degree of parent involvement, t(19) = 2.40, p = 0.027; DM = 1.15.

Conclusions: Childhood obesity programs vary depending on the behaviors they aim to change and the strategies they use. Successful programs tend to have two common traits: use of education-based strategies to ‘reduce screen time’, and a high degree of parent involvement. More research is needed to understand how additional strategies (behavior and environmental modification, and direct strategies) may improve program outcomes. Manualized protocols that have been evaluated and published are essential to build healthier communities. Translating research into practice and evaluating these practices is necessary to provide practitioners and clinicians with evidence-based programs and strategies to use with their populations, ultimately improving the health and well-being of all families.